Summary
Background
Proximal hypospadias and severe ventral chordee are often challenging to repair. To
preserve penile length in chordee repair, Small Intestinal Submucosa (SIS) corporal
grafting is often performed with potential long-term complications including recurrent
curvature and erectile dysfunction (ED). There is a paucity of data evaluating sexual
function in mid, late and post-pubertal patients.
Objective
We aimed to assess long-term outcomes of genital self-perception and erectile function
in mid, late and post-pubertal patients who underwent single-layer (1-ply) SIS corporal
body grafting for correction of severe chordee.
Study design
Patients with proximal hypospadias who underwent correction of severe chordee using
SIS grafting between 2001 and 2015 were retrospectively identified. Patients were
evaluated for erectile and sexual function using the modified erection hardness score
(mEHS) and the modified sexual health inventory for men (mSHIM). Perceived function
and straightness were measured with Hypospadias Objective Scoring Evaluation (HOSE).
Penile self-perception was assessed using the Pediatric Penile Perception Score (PPPS).
Results were compared to an age-matched healthy control group. Categorical variables
were analyzed using Fisher's exact test, and continuous variables using paired and
unpaired t-test and ANOVA.
Results
Nineteen patients with proximal hypospadias who underwent correction of severe chordee
using SIS grafting and 18 controls participated in the study with a median age of
17 years for both groups. In the mEHS, 12 (63.2%) hypospadias-patients and 14 (87.5%)
controls rated their erections as completely hard and very rigid. In the mSHIM, 1
(5.2%) hypospadias-patient was classified as having moderate ED. A total of 16 hypospadias-patients
(84%) and 16 controls (88.9%) reported being very satisfied or satisfied with the
straightness of their penis. No significant difference was observed in the mEHS, mSHIM
and PPPS between groups (p < 0.05). The straightness of the erection was rated lower
by participants, than by the pediatric urologist. In the HOSE, 12 (63.2%) hypospadias-patients
and 16 (88.9%) controls obtained an acceptable score.
Discussion
Our findings indicate favorable long-term outcomes in ED and genital self-perception;
only 5% of our population reported having a mild-moderate to moderate presentation
of ED, and there were no reports of severe ED. The overall PPPS satisfaction rates
were statistically similar for the control and hypospadias groups. The small sample
population limits the significance of our findings.
Conclusion
Summary TableComparison of outcomes from penile self-perception between the clinical and control
group.
| Very satisfied | Satisfied | Dissatisfied | Very dissatisfied | p-value | |||||
|---|---|---|---|---|---|---|---|---|---|
| Cases | Controls | Cases | Controls | Cases | Controls | Cases | Controls | ||
| Length of penis | 4 (21%) | 2 (11%) | 11 (58%) | 16 (89%) | 2 (10%) | 0 | 2 (10%) | 0 | 0.16 |
| Position and shape of urethral opening | 9 (47%) | 7 (39%) | 9 (47%) | 11 (61%) | 0 | 0 | 1 (5%) | 0 | 0.55 |
| Shape of glans | 9 (47%) | 8 (44%) | 9 (47%) | 10 (55%) | 0 | 0 | 1 (5%) | 0 | 0.62 |
| Shape of penile skin | 7 (37%) | 4 (22%) | 11 (58%) | 13 (72%) | 0 | 1 (6%) | 1 (5%) | 0 | 0.43 |
| Penile axis (straightness) | 5 (26%) | 6 (33%) | 11 (58%) | 10 (55%) | 2 (10%) | 2 (11%) | 1 (5%) | 0 | 0.76 |
| General appearance | 6 (31%) | 6 (33%) | 10 (53%) | 11 (61%) | 1 (5%) | 1 (6%) | 2 (10%) | 0 | 0.59 |
Keywords
Abbreviations:
SIS (Small Intestinal Submucosa), mEHS (Modified Erection Hardness Score), mSHIM (modified Sexual Health Inventory for Men), HOSE (Hypospadias Objective Scoring Evaluation), PPPS (Pediatric Penile Perception Score)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: June 29, 2022
Accepted:
June 25,
2022
Received in revised form:
June 7,
2022
Received:
March 10,
2022
Identification
Copyright
© 2022 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
